Healthcare Provider Details

I. General information

NPI: 1205084126
Provider Name (Legal Business Name): OKWU DME COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 FOREST LN STE 321
DALLAS TX
75243-6067
US

IV. Provider business mailing address

9550 FOREST LN STE 321
DALLAS TX
75243
US

V. Phone/Fax

Practice location:
  • Phone: 214-998-5789
  • Fax:
Mailing address:
  • Phone: 214-998-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number197606840
License Number StateTX

VIII. Authorized Official

Name: IKEOKWU O ONUOHA
Title or Position: OWNER
Credential:
Phone: 214-998-5789